A 51-Year-Old Man with Wrist Pain After a Fall

Differential Diagnosis

• Distal radius fracture
• Ulnar styloid fracture
• Scaphoid fracture
• Carpal-metacarpal dislocation
• Osteomyelitis distal radius

Diagnosis
The x-ray reveals a fracture of the ulnar styloid, as evidenced by a break in the cortex, displacement of the fracture fragment, and a loss of alignment of the trabeculations.

Learnings/What to Look For

• Approximately 50% of distal radial fractures will have associated ulnar styloid fracture.
• Ulnar styloid fractures can also occur as isolated injuries, as in this case.
• Most fractures are small avulsions at the tip, though occasionally involving the body or base of the styloid.
• Fractures through the base of the styloid can lead to instability of the distal radioulnar joint and injury to the triangular fibrocartilage complex.
• Accessory ossicles can appear similar to styloid avulsions.

Pearls for Initial Management and Considerations for Transfer

• With evidence of an isolated ulnar styloid fracture, search for a distal radius fracture or a carpal fracture or dislocation.
• If the neurovascular status is intact, the patient may be placed in an ulnar gutter or volar splint with recommendations.
• Indications for transfer include intractable pain, consideration of vascular injury, compartment syndrome, or associated displaced fracture or dislocation.

Acknowledgment: Image courtesy of Teleradiology Specialists.